Alternative PANRE Test Question: 18 Month Old Boy

An 18-month-old boy is brought in via ambulance after becoming unresponsive in the grocery store with his aunt. He was walking with her and became agitated when she would not allow him to get the candy he wanted. As he began to cry, his aunt observed him become somewhat cyanotic, after which, he squatted down for about 30 seconds before he suddenly collapsed. He was unresponsive for about 10 seconds before regaining consciousness.

Upon examination, you are able to hear a holosystolic murmur along the left sternal border that widely radiates throughout the precordium. What is the best initial intervention?

A. Echocardiogram
B. Behavioral counseling
C. Intravenous fluids
D. Immediate physician referral